I read the article by Smith et al1 with great interest. Our center has conducted research into shopping cart incidents since 1986, with observations of more than 5000 children and accompanying adults in field and laboratory settings.2-5 I would like to emphasize one of these themes: that significant reductions in these incidents will occur only when major design changes are made to shopping carts. Other remedies, such as educating parents about the risks to their children through prominent and powerful warning signs will have little effect.4 Extraordinary efforts to prompt parents to use seat belts in shopping carts have only modest influence.6
I differ with the authors' comments, however, about the role that the narrow stance of the rear wheels on carts plays in inducing injury and about the wisdom of focusing on this design feature. In our fieldwork, we have never observed a tip-over that
Harrell WA. Epidemiology of Shopping Cart-Related Injuries to Children. Arch Pediatr Adolesc Med. 1997;151(1):105. doi:10.1001/archpedi.1997.02170380109022
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